Healthcare Provider Details

I. General information

NPI: 1528809373
Provider Name (Legal Business Name): MEDSTAR CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6817 SOUTHPOINT PKWY STE 1302
JACKSONVILLE FL
32216-6297
US

IV. Provider business mailing address

PO BOX 550750
JACKSONVILLE FL
32255-0750
US

V. Phone/Fax

Practice location:
  • Phone: 904-902-0091
  • Fax: 904-600-5299
Mailing address:
  • Phone: 904-902-0091
  • Fax: 904-600-5299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VIRAL ACHARYA
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 904-902-0091